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Meaningful Use

Montana Immunization Program

Meaningful Use Information

Definition

Meaningful Use is using certified electronic health record (EHR) technology to:

  • Improve quality, safety, efficiency, and reduce health disparities
  • Engage patients and family
  • Improve care coordination
  • Maintain privacy and security of patient health information

Meaningful Use sets specific objectives that eligible professionals (EPs) and eligible hospitals (EHs) must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs.1

Roles and Responsibilities for Meaningful Use

Meaningful Use involves several entities so it may be difficult to know who to contact. Please refer to the table below for the appropriate contact agency best suited to answer your questions.

Role Responsible Agency Details
Set or clarify MU standards Office of the National Coordinator (ONC) meaningfuluse@cdc.gov The standards have been created by the Office of the National Coordinator (ONC), and ONLY ONC can interpret its intention in the standards.
Certify providers as meeting any MU standard ONC/CMS (Centers for Medicare & Medicaid Services), Provider ONC/CMS determine eligibility for incentive payments, and providers are required to self-certify as having met ONC's standards.
Certify or promote any EHR product as MU-ready Authorized Testing and Certifying Bodies (ATCBs) This certification is done by the Authorized Testing and Certifying Bodies (ATCBs) approved by ONC.
Adapt its immunization registry (IIS) to accommodate non-standard (i.e. other than HL7 2.3.1 or HL7 2.5.1) Electronic Health Record (EHR) submissions Public Health MU specifically requires that the EHR product be certified.  However, certification alone does not guarantee successful interoperation.  Public Health still has the responsibility to set the standards for data exchange to its IIS in order to maintain the quality of IIS data.  Public Health's Meaningful Use role is maintaining the IIS and providing the Local Implementation Guide.
Support the installation or configuration of any EHR and interface Vendor This is the vendor's role.2

1 http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives
2 http://www.cdc.gov/vaccines/programs/iis/meaningful-use/index.html#limits

Introduction

The Montana Immunization Program has the capability to receive electronic messages to help facilities meet Meaningful Use requirements. Included in the strategies for demonstrating Meaningful Use of EHR systems is the submission of immunization data to immunization registries or immunization information systems.

imMTrax, Montana’s immunization information system or IIS, contains official immunization records for all participating Montanans. imMTrax is a free program administered by the Montana Department of Public Health and Human Services (DPHHS) that electronically preserves a patient’s immunization record. imMTrax brings together multiple immunization records from Montana healthcare providers (public and private) and parental “shot cards” to form one complete record.

imMTrax uses data encryption for all data going to and from the IIS and is compliant with Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards.

Exclusions

The Montana Immunization Program is able to receive immunization messages in either HL7 2.3.1 or HL7 2.5.1; EPs and EHs cannot apply for an exclusion on this basis. If you administer vaccines to your patient population during your attestation time frame, you cannot be excluded from this measure. If you do not administer vaccines to your patient population, you must apply for an exclusion with Centers of Medicare and Medicaid Services (CMS) not public health.

Meaningful Use Stage 1

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Meaningful Use Stage 2

Meeting Public Health Meaningful Use Stage 2 Measures

An organization qualifies for Meaningful Use Stage 2 by meeting one of four scenarios as defined by the CDC (Centers for Disease Control and Prevention). Please review graphic below for more details:

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Meaningful Use Stage 2 Process Steps

Step One: Registration of Intent

Eligible Hospital (EH) or Eligible Professional (EP) notifies public health of interest in submitting immunization data for Meaningful Use.

  • Registration of Intent for Stage 2 is required regardless if registered for Stage 1 and/or if already achieved ongoing submission.
  • Complete the Montana Public Health Meaningful Use Registration Form before the 60th day of your reporting period.
  • Retain the automated email after completing the form as proof of meeting the Registration of Intent Meaningful Use step.

Registration message

  • Email Montana Immunization Program a listing of all sites included within the interface project.
  • Organization is placed into the Montana Immunization Program’s work queue.

Step Two: Waiting in the Work Queue

While the Montana Immunization Program is completing other interfaces, it is important for the organization to lay the groundwork for a successful interface.

Please Note-

  • Factors influencing the work queue priority status includes:
    • Completion of the Data-Exchange Pre-Testing Materials
    • VFC program enrollment
    • Number of immunizations administered
    • Number of sites associated with organization
    • Organization type (in general primary care providers will be prioritized over specialty clinics)
  • Waiting in the work queue qualifies you for meeting Meaningful Use Stage 2

Step Three: Invitation to Onboard and Establish Connection

The Montana Immunization Program sends an invitation to a registered EH or EP and confirms when a vendor has created a successful connection.

  1. The Montana Immunization Program emails an invitation to onboard containing the testing URL, user name, and password.
  2. Using test data only, establish connectivity by using either HTTPS or SOAP as a method of transportation.
  3. Vendor will alert Montana Immunization Program when a message has been sent so connection can be verified. Please note this may take several attempts.
  4. The Montana Immunization Program system is only able to review messages that were received with a successful connection. Therefore, we cannot easily troubleshoot connection issues.

Step Four: Testing Messages and Validation

Montana Immunization Program verifies the message structure and reviews the quality of the HL7 immunization messages.

4a. Testing of message structure

  1. Using test data, Montana Immunization Program verifies messages contain required, properly formatted segments and fields as identified in the imMTrax HL7 Data Exchange Specification Guide.

4b. Review of data quality

  1. Messages from the organization’s production system will be transmitted to the test environment of PHC-Hub (Montana’s immunization interface tool).
  2. After receiving a month’s worth of data*, the Montana Immunization Program will send a Request for Action email and provide a detailed report of errors and/or data quality issues to the vendor and organization. (*A month is an approximation. Some sites may require more or less time depending on the volume of immunizations.)
  3. The vendor and the organization will have 30 days to implement changes to correct the errors and/or data quality issues identified in the report.
    • If 30 days has passed with no response to the request, another Request for Action email will be sent.
    • An organization with two unmet Requests for Action emails may be suspended from onboarding and may not meet the Stage 2 Meaningful Use objective.
  4. Another detailed report will be provided and possibly more changes will need to be implemented. Please note it may take several attempts for issues to be addressed to a satisfactory level.

Step Five: Achieving On-going Submission & Maintenance

Quality messages are being received on a regular basis and periodic quality assurance activities are conducted.

  • Messages from the organization’s production system will be transmitted to the production environment of PHC-Hub. It will involve a new URL, username, and password.
  • Previous immunizations captured within the organization’s EHR may be requested for an initial data import into imMTrax.
  • VFC providers may need to change the method of recording the VFC inventory. If so, this will involve a workflow change and training between the State’s VFC Quality Specialist and the organization’s VFC Coordinator(s).
  • The organization’s staff will be responsible for the merging of client records. Training is available upon request.
  • A sampling of administered immunizations will be requested to verify imMTrax received the data correctly.
  • ACK messages (an HL7 message sent acknowledging receipt of message) will need to be reviewed by staff on a regular basis.
  • Data entry errors will need to be corrected by staff and possibly re-submitted.
  • Vaccine and/or manufacturer codes will need to be updated per CDC’s announcements.
  • Please alert the Montana Immunization Program to any system updates so any interruptions can be quickly resolved.